Nurse-Initiated X-Ray Requests for Extremity Trauma in the Emergency Department: A Single-Center, Prospective, Before-and-After Cohort Study.

Background: Emergency department overcrowding and prolonged stays are critical issues in health care. Nurse-initiated X-ray requests for isolated extremity trauma may streamline patient care.

Objective: This study aimed to assess the impact of nurse-initiated X-ray requests on patient care duration and overall management time in the emergency department.

Methods: This single-center, prospective, before-and-after cohort study included 400 patients at the University Hospital of Orléans, France, between January and June 2023. During the first period, X-rays were ordered by physicians. In the second period, triage nurses, trained through a comprehensive program, were authorized to order X-rays. The primary outcome was the duration of medical management from initial physician contact to the end of care. Secondary outcomes included overall emergency department management time and additional X-rays ordered after evaluation.

Results: Each period included 200 patients. The duration of medical care was significantly shorter in the second period (median, 21 minutes [interquartile rage, 9-56]) than the first period (median, 47 minutes [interquartile rage, 25-106]), with a median difference of -26 minutes (95% CI, -43 to -16; P<.001). The overall duration of patient management did not differ significantly between periods. Exploratory analyses suggested that a higher percentage of included patients on a given day correlated with shorter care durations for all attending patients.

Conclusion: The implementation of nurse-initiated X-ray requests was significantly associated with a reduction of approximately half an hour for patients with isolated limb trauma, although it did not affect the total duration of patient management. Further research is needed to evaluate the broader effectiveness of nurse-initiated X-ray requests in reducing emergency department management times.